Indonesian Journal of Medicine (IJM)
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Surgical Precision in Lumbar Spinal Canal Stenosis: Optimizing Outcomes in a Young Adult with Suspected Infection through Decompression-Stabilization-Fusion
Get PDFBackground: This case report examines the uncommon occurrence of Lumbar Spinal Canal Stenosis (LSCS) in a 23-year-old male patient, highlighting the diagnostic challenges and unique aspects of managing this condition in young adults. Typically associated with aging and degenerative changes, LSCS poses a diagnostic dilemma when encountered in a young individual with nonspecific causation.
Case Presentation: The patient reported persistent lower back pain since February 2023, primarily on the right side, escalating over the past three months. The pain intensified during prolonged sitting, standing, and walking, alleviated by lying down and analgesics. Radiating pain to both buttocks and legs, particularly on the right side, accompanied a four-month history of persistent right foot numbness. Referred from RS Siloam Kupang to RSAD Denpasar and subsequently to RSUP Prof IGNG Ngoerah, the patient received a diagnosis of Lumbar Spinal Canal Stenosis at L2-L3-L4, L5-S1, with suspected Spondylitis TB.
Results: This case underscores the intricacies of diagnosing Lumbar Spinal Canal Stenosis in young adults, emphasizing the exploration of non-traditional causes. The patient underwent Debridement-Decompression-Stabilization-Fusion-Biopsy+Culture, experiencing postoperative improvement. Cultures showed no growth, and biopsy results were nonspecific. The final diagnosis was Lumbar Spinal Canal Stenosis at L2-L3-L4, L5-S1 due to Spondylitis TB dd/Pyogenic Infection, with bilateral Neural Foraminal Stenosis Grade III at L5. The discussion focuses on the rarity of this presentation in young individuals, challenges in diagnosis, and the efficacy of decompression-stabilization-fusion treatment for achieving positive outcomes in young adult patients.
Conclusion: The case discussion emphasizes the complexity of managing Lumbar Spinal Canal Stenosis in a young adult, particularly when infection is suspected. The decision to pursue Decompression-Stabilization-Fusion was rooted in the patient's age, the need for structural stability, and the suspicion of infection
Application of the Health Belief Model for Assessing Risk Behavior among Patients Experiencing Musculoskeletal Pain Treated with Acupuncture in Surakarta
Get PDFBackground: Musculoskeletal pain is a complaint that occurs in parts of the skeletal muscles which is felt by a person ranging from mild complaints to very painful. This study aimed to analyze the effects of perceived vulnerability, perceived benefits, perceived barriers, and self-efficacy on risky behavior in patients complaining of musculoskeletal pain treated with acupuncture.
Subjects and Method: This was a cross-sectional study conducted in Surakarta, from November-December 2023. A total of 200 patients were selected using fixed disease sampling. The dependent variable was risk behavior for musculoskeletal pain. The independent variables were perceived vulnerability, perceived vulnerability, perceived benefits, perceived barriers, cues to action, and self-efficacy. The data were analyzed using a multiple linear regression.
Results: Musculoskeletal pain risk behaviors (MSDs) decreased with increasing perceived susceptibility (b= -0.22; 95% CI= -0.29 to -0.16; p<0.001), perceived benefit (b= -0.09; 95% CI= -0.13 to -0.05; p<0.001), and self-efficacy (b= -0.06; 95% CI= -0.11 to -0.01; p=0.015) and increased with increasing perceived barriers (b= 0.05; 95% CI= 0.02 to 0.09; p= 0.002).
Conclusion: Perceived vulnerability, perceived benefits, and self-efficacy decrease risk behavior in musculoskeletal pain patients, and perceived barriers increase risk behavior in musculoskeletal patients
A Rare Case Report of Gastric Adenocarcinoma with Pneumoperitoneum after Jejunostomy Feeding
Get PDFBackground: Gastric cancer is the third highest cancer mortality globally. This malignancy can result in emergency complications such as gastric perforation which results in pneumoperitoneum. Currently, there are not many case reports which describe pneumoperitoneum in gastric cancer. In this report, we describe a gastric adenocarcinoma with pneumoperitoneum following jejunostomy feeding.
Case Presentation: A 54 years old male presented with abdominal pain, black-colored feces, and body weight decrease as much as 22 kg within a month. The physical examination revealed anemic conjunctiva, distended abdomen with abdominal pain, and pale skin. On the lab examination, the hemoglobin level was 9.9 mg/dL. The peripheral blood smear showed signs of iron deficiency anemia caused by chronic process. An endoscopic examination and biopsy showed a gastric mass with well-moderately differentiated gastric adenocarcinoma. The three positions abdominal x-ray incidentally found that the patient had pneumoperitoneum.
Results: Patient was diagnosed with Adenocarcinoma Gaster based on a gastric mass biopsy with hematoxylin-eosin staining. Then, the patient was treated with jejunostomy feeding. Thoracic and 3-position abdominal X-ray examinations revealed incidental findings of pneumoperitoneum and small bowel obstruction.
Conclusion: Jejunostomy feeding in gastric cancer patient may result in pneumoperitoneum as a complication. Gastric adenocarcinoma followed by iron deficiency anemia from chronic process post jejunostomy feeding was found with pneumoperitoneum complication
Effectiveness of Acupuncture on the Quality of Life in Allergic Rhinitis Patients: Meta Analysis
Get PDFBackground: Allergic rhinitis (AR) is one of the most common health problems experienced by people around the world. WHO ARIA defines allergic rhinitis as a disorder of the nose accompanied by symptoms of sneezing, runny nose, itching, and nasal congestion e after the nasal mucosa is exposed to allergens mediated by immunoglobulin E (IgE). Many studies have proven the impact of acupuncture on the immune system. This study aims to examine and estimate the effectiveness of acupuncture therapy for allergic rhinitis patients based on the results of previous similar studies.
Subject and Method: This study is a systematic review and meta-analysis, with PICO as the following Population: allergic rhinitis patients. Intervention: acupuncture therapy. Comparison: sham/placebo acupuncture. Outcome: quality of life. The articles used in this study were obtained from several databases including Google Scholar, MEDLINE/PubMed, Science Direct, Hindawi, Europe PMC and Springer Link. These articles were collected for 1 month. The keywords to search for articles are as follows: "acupuncture for allergic rhinitis" OR "acupuncture for seasonal allergic rhinitis" OR "acupuncture for parenial allergic rhinitis" AND "quality of life" AND “randomized controlled trial". The article included in this study were a full text article with a randomized controlled trial (RCT) study design. Quality of life was measured using the Rhinitis Quality of Life Questionnaire (RQLQ). Meta analysis was written using PRISMA flow diagram and analyzed using Review Manager 5.4.
Result: A total of 9 RCT articles with a sample size of 2542 from Germany, Queensland, Victoria, China, and Korea were reviewed in this meta-analysis study. The results of data processing using the RevMan 5.4 application showed the effect of acupuncture therapy on the quality of life of allergic rhinitis patients. Acupuncture was able to lower RQLQ scores (improve quality of life), although it was not statistically significant. Allergic rhinitis patients who obtained acupuncture on average had a quality of life with an RQLQ score of 0.17 units, it was better than those getting sham acupuncture (SMD = -0.17; CI 95% = -0.40 to 0.05; p = 0.120).
Conclusion: There is an effect of acupuncture on the quality of life of allergic rhinitis patients.
Keywords: acupuncture, allergic rhinitis, quality of life, randomized controlled tria
Meta-Analysis: Effect of Hyperbaric Oxygen Therapy on Diabetic Foot Ulcer Recuperation
Get PDFBackground: Diabetes mellitus (DM) is a global phenomenon due to the high morbidity and mortality, especially in developing countries such as Indonesia. An ulcer is a wound and is usually found in patients who experience increased blood sugar and can cause peripheral blood vessel disorders, blood vessel disorders will result in peripheral neuropathy or a combination of both, diabetic ulcers are a condition often experienced by diabetes sufferers. Hyperbaric Oxygen Therapy (HBOT) is a therapy that is considered effective in healing diabetic ulcers and has been proven by many studies conducted. This study aims to analyze the effect of HBO therapy on the improvement of diabetic ulcer wounds.
Subjects and Method: This was a systematic review and meta-analysis of primary studies. Article searches were carried out based on the PICO model. Population: diabetic ulcer patients. Intervention: Hyperbaric Oxygen Therapy. Comparison: placebo. Outcome: diabetic ulcers condition. Article searches were carried out from Google Scholar, MEDLINE/PubMed, Science Direct, Scopus, Hindawi, BMC, and Spinger Link databases. Keywords used "diabetic foot ulcers" AND "hyperbaric oxygen therapy". The inclusion criteria were full paper, RCT, and reporting risk ratio (RR). Selected studies were analyzed using the RevMan 5.3.
Results: 9 RCTs from China, Canada, the Netherlands, Sweden, Egypt, Taiwan, England, and Turkey were selected for meta-analysis. HBO therapy increased diabetic ulcers condition (RR= 1.91; 95% CI= 1.17 to 3.12; p= 0.01).
Conclusion: HBO therapy improves diabetic ulcers condition.
Keywords: hyperbaric oxygen, diabetic foot ulcer, meta analisis
Nurse’s Characteristics and Their Understanding Regarding the Compatibility of Mixing Intravenous Drug Preparations in Hospital Settings
Get PDFBackground: Drug incompatibility can occur in patients in hospital who receive one or more drugs at the same time due to incompatible drug mixing, and the mixture is said to be incompatible if there are precipitates, crystals, visual color changes. This research aims to determine the relationship between nurses' knowledge of incompatibility in mixing intravenous drug preparations, so that collaboration between nurses and pharmacists can occur in administering intravenous drugs and can reduce the occurrence of medication errors, especially when administering intravenous drugs.
Subjects and Method: Cross sectional research was conducted in RSUD dr. Soeselo, Tegal, Central Java, November 2023. The research subjects were 152 nurses selected using purposive sampling technique. The dependent variable is knowledge. The independent variables are age, gender, length of work, duration of work, and training. Data was collected using a questionnaire and analyzed using multiple linear regression.
Results: The number of survey respondents in this study was 152 people, with the majority being 73.7% female and 26.3% male. The average value of the nurses' age was 31.82 ± SD 5.09 and 6.14 ± SD 3.26 for the length of work of the nurses who took part in this study, and the average duration of work was 10.08 ± 2.00. In the multivariate analysis test, gender, last education, duration of work, length of work, age on knowledge had a p value of >0.005 so there was no significant effect.
Conclusion: The majority of nurses still have a poor level of knowledge <75% on several questionnaire items. Apart from that, this research shows that there are still many nurses who do not understand intravenous stability and the stages of intravenous administration, which is shown in the question scores. So the role of clinical pharmacy in monitoring and providing education regarding nurse training regarding drug incompatibility is needed.
Successful Combination Therapy with Phototherapy and Topical Corticosteroid in a Rare Case : 57 Years Old Male Patient with Lichen Amyloidosis
Get PDFBackground: : Lichen Amyloidosis (LA) is one of the most common forms of primary localized cutaneous amyloidosis, with clinical manifestations of itchy blackish brown hyperkeratotic papules. The most predilection site is the upper extensor of the legs. This case report aims to improve the clinician’s knowledge regarding clinical features and supporting examinations to the provision of appropriate therapy in LA.
Case Report: A 57 years old farmer presented to dermatology and venereology outpatient clinic of Dr. Moewardi general hospital with itchy black spots on nearly all over his body since 2 years ago. Dermatology examination obtained generalized papules and scaly hyperpigmented patches. Dermoscopy revealed a scar-like center with a whitish color in the center. Histopathological examination showed an amorphous eosinophilic (amyloid) in the dermis. Congo red examination demonstrated a reddish-orange amyloid. We treated the patient with oral cetirizine 10 mg/day, desoximetasone 0.25% cream applied twice a day in the morning and in the evening, Carmed® cream 20% cream applied twice a day in the afternoon and night, phototherapy 350 MJ/cm2 twice a week. We observed for 14 weeks. The lesion and itching started improving in week 8.
Result: Lichen amyloidosis is resulted from amyloid deposits in the papillary dermis which are derived from degradation of basal keratinocytes. The diagnosis is based on history taking, clinical examination, dermoscopy and skin biopsy. The combination of phototherapy and topical corticosteroid can be an option for LA therapy, especially for the symptom of pruritus.
Conclusion: Lichen Amyloidosis is the most common type of primary localized cutaneous amyloidosis, presents as blackish brown hyperkeratotic papules. The combined therapy of topical corticosteroids and phototherapy can significantly improve pruritus and skin lesions
Multilevel Analysis of Prognostic Factors for Cognitive Function in Post-Stroke Patients
Get PDFBackground: Stroke is the leading cause of disability and the second leading cause of death worldwide. Post-stroke disability can be in the form of motor, sensory, autonomic, or cognitive impairments. Impaired cognitive function is the leading cause of death and pain in post-stroke patients in the world. Decreased cognitive function is present in more than 70% of post-stroke patients and is associated with disability, independence, and pain. This study aims to analyze the prognosis factors of cognitive function in post-stroke patients.Subjects and Method: This study used a cross-sectional design conducted in 7 hospitals on the island of Lombok from July to August 2024. A total of 200 post-stroke patients were selected using stratified random sampling. The dependent variable in this study was cognitive function examined using the Mini Mental State Examinatio (MMSE) questionnaire. Other independent variables such as age, gender, marital status, pension fund, complications, comorbidities and stroke type were collected using a questionnaire. The data were analyzed using a multilevel double-linear regression model.Results: The prognosis factor of cognitive function in post-stroke patients was age (b=-0.19; CI 95%=-0.29 to -0.10; p=<0.001), marital status (b=-3.80; CI 95%=-6.72 to -0.88; p=0.011), pension fund (b=-5.88; CI 95%= -8.35 to -3.42; p=<0.001), complications (b=-5.37; CI 95%= -7.34 to -3.39; p=<0.001). While sex, comorbidities, and stroke type did not show a significant relationship with the cognitive function of post-stroke patients. Conversely, there was an influence of doctors treating post-stroke patients on cognitive function (ICC=8.76%).Conclusion: Age, marital status, pension funds, and complications are prognostic factors in cognitive function of post-stroke patients. Conversely, there is an influence of doctors who treat post-stroke patients on cognitive function
Relationship of Neutrophil Lymphocyte Ratio and Glomerulus Filtration Rate in Diabetic Nephropathy Patients at H. Adam Malik Hospital, Medan, Indonesia
Get PDFBackground: Diabetic nephropathy is a serious complication of diabetes mellitus (DM). The neutrophil-lymphocyte ratio is the result of the relative count of neutrophils divided by the relative number of lymphocytes in diabetic nephropathy patients in % units obtained from routine hematology results using EDTA blood samples and measured by flow cytometry with Sysmex XN-1000, glomerular filtration rate was measured according to the Cockroft-Gault formula. This study aimed to determine the relationship between neutrophil lymphocyte ratio (NLR) and glomerular filtration rate in diabetic nephropathy patients.
Subjects and Method: This was a cross sectional study conducted at H. Adam Malik Hospital, Medan, North Sumatera, Indonesia, from November 2022 – January 2023. 30 diabetic nephropathy patients were selected for this study consecutively. The dependent variable was the glomerular filtration rate. The independent variable was the NLR. Blood sample was taken for a complete blood count and creatinine examination. Data were analyzed using the Spearman test.
Results: NLR was negatively associated with eGFR in patients with diabetic nephropathy, but it was statistically non significant (r= -0.25; p= 0.186).
Conclusion: NLR is negatively associated with eGFR in patients with diabetic nephropathy, but it is statistically non significant.
Keywords: neutrophil lymphocyte ratio, glomerular filtration rate, diabetic nephropath
Effect of Manual Therapy in Reducing Neck Pain in Patients with Hernia Nucleus Polposus Cervicalis
Get PDFBackground: Herniated Nucleus Pulposus Cervicalis (HNPC) is a medical condition characterized by the posterior or posterolateral protrusion of the intervertebral disc, resulting from the degeneration of the fibrous annulus. This protrusion exerts pressure on the nerve roots and spinal cord, leading to the development of neurological disorders. The objective of this study was to assess the efficacy of manual therapy in alleviating neck pain among patients diagnosed with cervical herniated nucleus pulposus.
Subjects and Method: A randomized controlled trial was carried out at JIH Hospital in Yogyakarta from August to September 2023. Fourteen patients diagnosed with cervical herniated nucleus pulposus (HNPC) were purposively sampled for the study. Seven patients underwent manual therapy as an intervention, while the remaining seven received standard treatment as the control group. The dependent variable assessed was neck pain, measured using a visual analogue scale (VAS). The independent variable was orthopedic manual physical therapy. The differences in neck pain scores between the two groups were analyzed using an independent t-test.
Results: Following the intervention, the pain score in the intervention group (Mean 2.43; SD= 1.13) exhibited a significant reduction compared to the control group (Mean= 4.86; SD= 0.90), with a p-value of 0.001.
Conclusion: Orthopedic manual therapy effectively alleviates neck pain in individuals with cervical herniated nucleus pulposus